Pandemic Event


OSHA recently solidified leadership for the agency and has provided a clearer picture of the regulatory horizon.

First of all, David Michaels, PhD, MPH, assumed his position as head of OSHA when the Senate confirmed his nomination as assistant secretary of Labor for occupational safety and health. Nominated by President Barack Obama on June 28, the Senate acted on the nomination December 3.

Michaels, an epidemiologist, has been a professor at the George Washington University School of Public Health and Health Services in Washington, DC, and is also the author of Doubt is Their Product: How Industry’s Assault on Science Threatens Your Health.

Agency watchers assumed that any work on new, and perhaps controversial, standards, would await the establishment of a permanent director.

While Michaels as settling in, Secretary of Labor Hilda L. Solis held an online Q&A session Dec. 7 to discuss regulations at the Department of Labor.

Solis announced that OSHA is considering airborne infectious disease protection for healthcare workers and will publish a request for information in the Federal Register in March.

A standard would require healthcare employers to protect workers from tuberculosis, severe acute respiratory syndrome (SARS), and influenza, such as H1N1, on which OSHA recently issued an enforcement directive.

When asked if an airborne infectious disease standard would be modeled after the California version, which took years to achieve consensus among employers, labor and other stakeholders, Solis said the California standard “would certainly be one important piece of information that OSHA will consider in deciding whether to propose or issue a standard.” She would not predict how long it would take to issue a final standard.

Also, Solis confirmed that although OSHA has conducted several inspections, it has not yet issued any citations based on the H1N1 enforcement directive.

In an OSHA-specific session later that day, HealthLeaders Media asked OSHA interim director Jordan Barab, if the absence of airborne infectious disease standard has hampered the agency with regard to its H1N1 educational preparedness and enforcement activities?

“No, it has not hampered us,” said Barab. “While a standard on airborne transmissible diseases would have been preferable, we believe that we are responding to the issues effectively using existing standards and the General Duty Clause.”

On the matter of issuing an industry-wide ergonomics standard, both Solis and Barab reiterated—word-for-word in fact—”At this time, OSHA has no plans for regulatory activity.” Both said that a proposal to reinstate the work-related musculoskeletal disorders column on the OSHA 300 Injury Log was not a prelude to issuing such a standard.

Concerning an industry-specific ergonomic standard, such as one for safe patient handling standard, Barab said,” There are many options that OSHA might consider if the agency decides to pursue rulemaking in this area. Industry specific standards is one option that would be considered.”


David LaHoda, the managing editor of Medical Environment Update and OSHA Watch, has produced healthcare training videos and consulted for medical practices and ambulatory healthcare facilities.

AUGUST 19, 2009

CDC is releasing new guidance that recommends actions that non-healthcare employers should take now to decrease the spread of seasonal flu and 2009 H1N1 flu in the workplace and to help maintain business continuity during the 2009–2010 flu season. The guidance includes additional strategies to use if flu conditions become more severe and some new recommendations regarding when a worker who is ill with influenza may return to work. The guidance in this document may change as additional information about the severity of the 2009-2010 influenza season and the impact of 2009 H1N1 influenza become known. Please check www.flu.gov periodically for updated guidance

Introduction

The U.S. Department of Health and Human Services’ (HHS) Centers for Disease Control and Prevention (CDC), with input from the U.S. Department of Homeland Security (DHS), has developed updated guidance for employers of all sizes to use as they develop or review and update plans to respond to 2009 H1N1 influenza now and during the upcoming fall and winter influenza season. Businesses and employers, in general, play a key role in protecting employees’ health and safety, as well as in limiting the negative impact of influenza outbreaks on the individual, the community, and the nation’s economy. Employers who have developed pandemic plans should review and revise their plans in light of the current 2009 H1N1 influenza outbreak to take into account the extent and severity of disease in their community as outlined in this guidance.

Planning for Fall and Winter Influenza Season

Businesses may have already been impacted by the spring and summer outbreaks of 2009 H1N1 influenza affecting their employees. CDC anticipates that more communities may be affected than were in the spring/summer 2009, and/or more severely affected reflecting wider transmission and possibly greater impact. In addition, seasonal influenza viruses may cause illness at the same time as 2009 H1N1 this fall and winter. In response to the anticipated spread of 2009 H1N1 influenza, the CDC has revised its recommendations to assist businesses and other employers of all sizes.

The severity of illness that 2009 H1N1 influenza flu will cause (including hospitalizations and deaths) or the amount of illness that may occur as a result of seasonal influenza during the 2009–2010 influenza season cannot be predicted with a high degree of certainty. Therefore, employers should plan to be able to respond in a flexible way to varying levels of severity and be prepared to refine their pandemic influenza response plans if a potentially more serious outbreak of influenza evolves during the fall and winter. More people and communities are likely to be affected as influenza is more widely transmitted. The CDC and its partners will continuously monitor national and international data on the severity of illness caused by influenza, will disseminate the results of these ongoing surveillance and will make additional recommendations as needed.

FOR THE COMPLETE GUIDE GO TO http://www.flu.gov/plan/workplaceplanning/guidance.html

In 2006 an article was published on pandemic awareness:

Many organizations have planned for disasters, some with an impressive array of activities including practice drills, tabletop exercises, and extensive implementation plans. While all of these activities are essential to minimizing the impact and costs of natural disasters for terrorist activities, they will prove inadequate for pandemic events such as an outbreak of a new strain of influenza.

Experts say a pandemic will feel more like a war or a severe economic crisis than an earthquake, hurricane, or act of terrorism. As a result, a pandemic threat requires a unique approach to planning and a different set of skills and preparation than traditional disaster preparedness activities.
 
“Organizations that depend upon existing, on-the-shelf disaster plans will pay a heavy price during a pandemic event,” said Bob Blitzer, an ICF International vice president in emergency management. “Within a few days, the organization will realize that it is unprepared to respond to the needs of its employees, its customers, and its community.”

U.S. federal officials who have been planning for potential pandemic events have made it very clear that this is a unique threat, unlike any natural or man-made disaster.

“The pandemic threat is different…the significant mobility of human populations means that every corner of the globe and every element of society are likely to be touched. This widespread effect has ramifications not only for the health and well being of populations, but for the national and economic security of the nations, and the functioning of society. Once this fundamental premise is recognized, the scope and scale of the measures necessary to prepare for a pandemic become apparent.”1

It also is apparent to the experts involved in planning for a pandemic event that relying solely on the health and medical communities to respond to this kind of a crisis is unrealistic and potentially dangerous. Officials point out that the vast majority of the actions that will be taken will occur from nontraditional sources. Federal support will be substantially less than in the case of traditional disasters, and because of the scope of the problem, traditional “mutual assistance” agreements with neighboring communities and states will be virtually useless.

“They all think the cavalry is going to arrive and do all the ‘heavy lifting,’” said Anita Tallarico, an ICF senior vice president describing state and local agencies and the business community. “However, government officials emphasize that local communities must prepare to be able to help themselves for at least three days.”

The President’s Implementation Plan clearly states that the primary burden of responding will fall on nongovernmental institutions. “More than 85 percent of critical infrastructure is owned and operated by the private sector. Therefore, sustaining the operations of critical infrastructure under conditions of pandemic influenza will depend largely on each organization’s development and implementation of plans for business continuity while facing staffing shortages and the need to protect the health of its workforce.”2

This will require a major “shift in thinking” for businesses that are not accustomed to taking care of health needs for employees while simultaneously trying to sustain business operations with limited staff and absence of other normal support services for an extended period of time.

“When we go in and work with a client on a training exercise and help with planning,” said Blitzer—who formerly headed up the Weapons of Mass Destruction response operations at the Federal Bureau of Investigation—“the client quickly realizes that its traditional way of thinking about disaster planning is completely inadequate. Once stakeholders realize how quickly a pandemic outbreak occurs, and the fact that it is inevitable that another one will occur in our lifetime, their thinking changes.”

Here are just a few of the assumptions federal officials make as they plan for a pandemic event. These assumptions also must be incorporated into planning efforts in the private sector and by state and local agencies.

  • Susceptibility will be universal.
  • Civil disturbances and breakdowns in the public order may occur.
  • Typically, illness rates will be highest among school-aged children (about 40 percent) and decline with age. Among working adults, an average of 20 percent will become ill during a community outbreak. Actual illness rates by age, however, will depend on the characteristics of the new virus and may vary from these rates.
  • Risk groups for severe and fatal infection cannot be predicted with certainty, but are likely to include infants, the elderly, pregnant women, and persons with chronic or immunosuppressive medical conditions.
  • In a severe pandemic, absenteeism rates of 40 percent or higher may result from individual illness, the need to care for ill family members, and fear of infection.
  • Typically, the risk of transmission (viral shedding) will be greatest during the first two days of illness. Children will play a major role in spreading the disease.
  • On average, infected persons will transmit infection to approximately two other people.
  • Isolation and quarantine measures are likely, as are mandatory restrictions on domestic and international travel.
  • Epidemics will last six to eight weeks in affected communities.
  • Multiple waves of illness are likely to occur, with each wave lasting two to three months.

Things are now closer than anyone ever thought it would happen.  On 23 rd April 2009 the world began to become aware of a very strange new version of swine flu H1N1 in Mexico with limited cases in Texas and California. By the morning of the 24th of April, we began hear that there were hundreds of sick and 20 or so dead. By late in the day, we have learned that over 1,000 are now reported ill and over 60 are reported dead. There are solid reasons to suspect that this new Mexican Swine Flu is NOT a naturally occurring event but instead is an Advanced Biological Warfare recombination DNA genetically engineered virus.

Here is what we know of the virus so far. This virus has already gone international having crossed the border from Mexico to America. All schools in Mexico City have been canceled, millions of students told to stay home due to Mexican Swine Flu. Sick victims of this strange new virus are currently reported in California and Texas. Over 60 deaths reported in Mexico (could be substantially higher considering the state of Mexican health care and reporting).

Young healthy adults seem to be the most at risk. This is similar to the deadest killer flu in history, Spanish Flu in 1918. Most if not all nations with advanced biological warfare programs have been interested in recreating the Spanish Flu DNA sequence and several are reported to have done so.

The new Mexican Swine Flu has elements of DNA from the following: avian flu, human flu Type A, human flu Type B, Asian swine flu, and European swine flu. A strange combination never seen before and having less than 1/10% chance of being a natural event. Human and animal viruses from four or more continents suddenly recombine in a new flu during a non-flu season that spreads from human-to-human with a 10% fatality rating.